Health behavior change models for HIV prevention and AIDS care: Practical recommendations for a multi-level approach

Michelle R. Kaufman, Flora Cornish, Rick S. Zimmerman, Blair T. Johnson

Research output: Contribution to journalArticlepeer-review

115 Scopus citations


Despite increasing recent emphasis on the social and structural determinants of HIV-related behavior, empirical research and interventions lag behind, partly because of the complexity of social-structural approaches. This article provides a comprehensive and practical review of the diverse literature on multi-level approaches to HIV-related behavior change in the interest of contributing to the ongoing shift to more holistic theory, research, and practice. It has the following specific aims: (1) to provide a comprehensive list of relevant variables/factors related to behavior change at all points on the individual-structural spectrum, (2) to map out and compare the characteristics of important recent multi-level models, (3) to reflect on the challenges of operating with such complex theoretical tools, and (4) to identify next steps and make actionable recommendations. Using a multi-level approach implies incorporating increasing numbers of variables and increasingly context-specific mechanisms, overall producing greater intricacies. We conclude with recommendations on how best to respond to this complexity, which include: using formative research and interdisciplinary collaboration to select the most appropriate levels and variables in a given context; measuring social and institutional variables at the appropriate level to ensure meaningful assessments of multiple levels are made; and conceptualizing intervention and research with reference to theoretical models and mechanisms to facilitate transferability, sustainability, and scalability.

Original languageEnglish (US)
Pages (from-to)S250-S258
JournalJournal of Acquired Immune Deficiency Syndromes
Issue numberSUPPL.3
StatePublished - Aug 15 2014


  • HIV
  • behavior change
  • factors
  • multi-lev
  • socio-ecological model

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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